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CITY OF OSHKOSH N2 44361
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLBG SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS fl ( 5 11Y1 M Q.ntr�.
/n,�,,, c ,� (� PLAN NO.
OWNER ickl i TC 1a
DESIGNER /j �
USE/NATURE OF WORK f fLOJS Ot u Y� b J1Q a
BUILDING CONTRACTOR
Size Sq. Ft. # Rooms # Stories Height
Foundation Class of Const. Occupancy Permit
HEATING CONTRACTOR
Heat ❑ A/C ❑ Vent p Fuel /System Heat Loss BTU'S
ELECTRIC CONTRACTOR
Electric Serv. New ❑ Change ❑ Temp ❑ Type Volts Amps
Fixtures Switches Receptacles Circuits
PLUMBING CONTRACTOR al/yin/in/5
BT WH _ Disp _. WSoft — CBasin �l
- Lav Sh - DW DF — San. Sewer
- WC _ FDr - SP _ Ur — Storm Sewer
— Sink _ LTub Eject — SS _ Water
Other
CD
FEES: Valuation $ M Permit Fee Paid $ i Park Dedication $
C
ISSUED BY Date C .S Final /O.P.
In the rk I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE
AGENT /O ER DATE
ADDRESS
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